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KMID : 0378019740170010083
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New Medical Journal
1974 Volume.17 No. 1 p.83 ~ p.96
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Sociocultural Problems on the Discharged Cases from A Neuropsychiatric Ward
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Abstract
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The authors tried to evaluate the sociocultural and clinical characteristics of discharged cases from a neuropsychiatric ward in a general hospital in Seoul.
Materials were collected from all the discharged cases from the neuropsychiatric ward of Kyung Hee University Hospital during the last two years from November 1, 1971 to October 31, 1973. Two hundreds and seventy eight cases (male:160, female:118) were discharged during the above mentioned period. Most of the patients are self-supported for hospitalized treatment.
Diagnostic distribution: Forty one percent is schizophrenia: 20.5 per cent, psychoneuroses :20.5 percent, organic cases: 3.24 percent, manic depressive illness: 3.24 percent, senile psychosis: 3.96 percent, alcoholism with delirium tremens and so on. Special attention was given to the high percentage of hysteria (11.86 percent among the total, 22.03 percent among the females), the increasing tendency of senile psychosis, alcoholism, general paresis (1.44 percent) and arteriosclerotic psychosis(2.52 percent). Subgroup of schizophrenia is revealed simple type in 9.65 percent, catatonic type in 3.51 percent, hebephrenic type in 4.39 percent, paranoid type in 44.73 percent, pseudoneurotic type in 6.14 percent, schizoaffective type in 11.40 percent, acute undifferentiated type in 13.16 percent and chronic undifferentiated type in 7.01 percent.
Age of the patients:: Mean age and standard deviation are 28.41±9.90(male:28.09±10.18, female: 28.76±9.67) as a whole, 27.42±8.86 (male: 28.14±9. 34, female: 26.19±8.43) in schizophrenia, 30,39±11.29 (male: 27. 88±13. 15, female: 31.45±10.17) in psychoneuroses. Teenagers and the aged over 60 years of age are 16.19 percent and 3.60 percent respectively.
Sociocultural status: Educational background of the patients is relatively high: the status is distributed to college in 35.25 percent, high and junior school in 46.75 percent, primary school in 16.18 percent and illiteracy in 1.82 percent. They have religions in 44.57 percent. Schizophrenic patients seem to be married later than other groups. Social class of the familly adapted to the frame of Hollingshead and Redlich is manifested as follows: class I and II is 36.34 percent: class III, 33.45 percent: class I V and V, 30.21 percent. Educational background of head of the family is distributed to college in 44.61 percent, high and junior school in 23.78 percent, primary school in 14.04 per cent and illiteracy in 4. 31 percent. The heads of the family have various religions in 46.01 percent. Rate of parental deprivation before 15 years of age is apparently higher in schizophrenic group than other ones: paternal deprivation seems to be more important than maternal one.
Clinical Problems: Seventy five percent of all the disharged cases were admitted to as fresh cases without any previous psychiatric admission. Thirty three percent of total cases, however, has past history of treatment with traditional herb medicine, folk or magical devices, internal medicine and or neurosurgery. The traditional concept of mental illness and mode of treatment which troubled with those of modern medicine are intermingled with the confused channel of seeking medical care in Korea. They were admitted to through various channels: & 28 percent by psychiatrists´ referring, 15.84 percent by other physicians´ referring, &28 percent transferred from other departments, 6.12 percent by patient´s own seeking, and 57.93 percent by family members´ own seeking and so on.
Mode of treatment in hospital setting is also various and multiple. Pharmacotherapy is the major mode of treatment, i. e. 89.56 percent of all cases and 98.24 percent of the schizophrenic group were treated with pharmacotherapy. Electric shock therapy was applied to 25.17 percent of total cases and to 51.75 percent in the schizophrenics, whereas insulin shock therapy was applied to only one case of schizophrenia. Supportive psychotherapy was applied to 21.58 percent of total cases, to 28.94 percent in schizophrenics and to 33.33 percent in psychoneuroses. On the other hand, intensive psychotherapy was applied to 12.23 percent of total cases, to 10.52 percent in psychoneuroses and to 20.17 percent in schizophrenics, whereas group therapy, to 38.84 percent of total cases, 40.35 percent in psychoneuroses and 59.64 percent in schizophrenics. Family therapy was tried to 10.43 percent of all cases, 14.03 percent and 14.91 percent in psychoneuroses and schizophrenics respectively. Milieu therapy including art therapy, recreation, occupational therapy and other active participation to ward activities was applied to 4&20 percent of all cases and 81.57 percent in schizophrenics.
Mean day of hospitalization is 30. 12±37. 17 for all cases, 15. 82±23. 31 for psychoneuroses and 48.59±39.05 for schizophrenics. They were discharged against medical advice in 44.62 percent. Successful follow-up treatment was possible only in 39.21 percent for all cases, 22.45 percent for psychoneuroses and 50 percent for schizophenics inspite of intensive approach and special emphasis to follow-up during hospital staying.
Consequently, psychiatric practice in Korea is crucially hampered by poorly socialized medical system and financial difficulty as well as conceptual discrepancy about mental illness between the traditional medicine or the public and the modern medicine. Reasonable delivery system and education for the public are inevitable and necessary for the improvement of psychiatric practice and mental health.
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